Elderly sometimes keep using opioids after surgery

NEW YORK (Reuters Health) - One in ten older adults prescribed a powerful painkiller after surgery was still filling prescriptions for the drug a year later, a new study from Canada shows.

Because so-called opioids, which include codeine and OxyContin, have a higher risk of abuse and overdose than other painkillers, researchers say the drugs should be prescribed carefully and patients followed closely.

The patients in the current study hadn't taken opioids before their surgeries, and all of the procedures were considered low-pain.

"You're sort of introducing something which was originally intended for a very transient event, and even that transient event might not have required codeine," said Dr. Chaim Bell from St. Michael's Hospital in Toronto, who worked on the study.

Bell's team found that out of close to 400,000 patients age 66 years and older who had short-stay surgery in Ontario between 1997 and 2008, about seven percent were prescribed an opioid -- most commonly codeine -- within a week of being discharged from the hospital.

A year later, one out of every ten patients initially prescribed the painkillers was still taking opioids. On average, those longer-term users had filled prescriptions for 33 pills during the year, and some were taking stronger opioids than they'd first been prescribed.

Patients who were prescribed post-surgery opioids were 44 percent more likely to be taking them a year later than those whose doctors didn't initially prescribe the drugs, Bell's team reported on Monday in the Archives of Internal Medicine.

The researchers didn't have notes on why each patient was prescribed painkillers, so they couldn't tell if the older adults were still treating surgery-related pain a year later, or if they had a new injury or illness in the interim.

Still, the findings suggest that surgeons should reconsider prescribing opioids to patients who haven't had high-pain surgery because of longer-term risks, researchers said.

"It's much easier to stop something's initiation rather than weaning someone off it afterwards," Bell told Reuters Health.

He said surgeons typically have a generic post-surgery form for all patients that gives them the option to prescribe powerful painkillers -- but maybe that choice isn't needed and shouldn't even be offered after low-pain surgeries, according to Bell.

When patients do really need opioids, he said, there should be better communication between the prescribing surgeon, the patient and that patient's primary care doctor about whether they'll need any drug refills and what to expect from the recovery process.

Patients themselves, he added, can ask their surgeons: "How long do I need to be on these for? When should the pain go away?"

It may be especially important to think twice about opioids in elderly patients, said Dr. Daniel Solomon, who has studied effects of the drugs at Harvard Medical School in Boston.

"We in general are concerned about toxicities of all medications in the elderly," said Solomon, who wasn't involved in the new study.

"Because opioids are associated with cognitive changes as well as changes in balance, the elderly are at high risk of some of the potential adverse effects."

Solomon said he wasn't aware of any research showing that the elderly are more or less at risk of abusing opioids compared to younger patients.

Just how addictive the painkillers are remains a controversial issue. But as prescriptions for the drugs have skyrocketed in recent years, the number of people abusing and overdosing on them has increased as well. According to the Centers for Disease Control and Prevention, 14,800 people were killed by a prescription drug overdose in 2008.

Cutting back on opioid prescribing and use is an important goal, researchers agreed -- but it's unclear how best to make sure that happens.

Solomon, like Bell, suggested more discussions between doctors and patients about potential risks with opioids, as well as systems that would link medical, pharmaceutical and insurance records and alert doctors when patients are refilling their painkiller prescriptions.

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